切开复位内固定治疗有移位髋臼骨折的疗效分析

Analysis of clinical outcome in open reduction and internal fixation for displaced acetabular fracture

目的 观察切开复位内固定治疗有移位髋臼骨折的远期疗效 ,并分析影响远期疗效的相关因素。方法 本组按Letournel Judet分型简单骨折 2 3例 ,复杂骨折 31例 ,骨折移位≥ 3mm ,合并髋关节后脱位 16例 ,中心性脱位 13例 ,股骨头软骨面损伤 17例。均采用切开复位钢板螺钉内固定 ,其中伤后 2周内手术 4 2例 ,3周后手术 12例。结果 术后平均随访 38个月 ,Matta关节评分 >15分、Liebergall影像学评价A、B的病例 4 3例 ,优良率 79 6 % ,3年后全髋置换 5例 ,占 9 3%。 结论 切开复位内固定能使髋臼恢复正常解剖形态 ,有利于关节功能的恢复 ,远期疗效较好 ;Letournel Judet骨折分型、股骨头软骨面是否损伤、骨折后手术时间以及复位质量是主要影响因素 ,提示髋臼创伤骨折的严重程度直接影响其预后。

Objective To evaluate the long-term results of open reduction and internal fixation for the treatment of acetabular fracture,and discuss the factors which influence the long-term results Methods According to Letournel-Judet classification,23 cases were simple fractures,and 31 cases complex fractures.All fractures displaced more than 3 mm.16 cases were combined with posterior hip dislocation,13 cases with central hip dislocation,and 17 cases with femoral head damage.All the cases were treated with open reduction and internal fixation.42 cases were operated within 2 weeks,12 cases were operated after 3 weeks of trauma.Results All cases were followed up with an average of 38 months,with Mattas joint function evaluation system and Libergall radiography evaluation system.The percent of successful outcomes was 79.6%.5 cases (9.3%) were treated with total hip replacement after 3 years.Conclusion Open reduction and internal fixation can result in a satisfactory clinical outcome.Four factors were found to influence the clinical outcome:Type of fractures(according to Letournel-Judet classification),cartilage damage of the femoral head,quality of reduction and operation time after trauma,which implies that traumatic degree of the acetabulum directly influences the prognosis.